Tuesday, April 12, 2016

Impact of Mental Health and Substance Use Disorders on Emergency Department Visit Outcomes for HIV Patients

INTRODUCTION:

A
disproportionate number of individuals with human immunodeficiency virus (HIV)
have mental health and substance-use disorders (MHSUDs), and MHSUDs are
significantly associated with their emergency department (ED) visits. With an
increasing share of older adults among HIV patients, this study investigated
the associations of MHSUDs with ED outcomes of HIV patients in four age groups:
21-34, 35-49, 50-64, and 65+ years.

METHODS:

We used
the 2012 Nationwide Emergency Department Sample (NEDS) dataset (unweighted
n=23,244,819 ED events by patients aged 21+, including 115,656 visits by
patients with HIV). Multinomial and binary logistic regression analyses, with
"treat-and-release" as the base outcome, were used to examine
associations between ED outcomes and MHSUDs among visits that included a HIV
diagnosis in each age group.

RESULTS:

Mood and
"other" mental disorders had small effects on ED-to-hospital
admissions, as opposed to treat-and-release, in age groups younger than 65+
years, while suicide attempts had medium effects .

Cognitive disorders had medium-to-large
effects on hospital admissions in all age groups and large effects on death in
the 35-49 age
groups.

Alcohol use disorders (AUDs) had small effects on hospital admission in
all age groups.

Drug use disorders (DUDs) had
small-to-medium effects on hospital admission. AUDs
and DUDs were also significantly related to the risk of death, and DUDs had a
small effect on the risk of discharge against medical advice in the 35-49 and
50-64 age groups.

CONCLUSION:

The
high prevalence of MHSUDs and their significant roles in ED visit outcomes in
patients with HIV provide support for integrated care for these patients
outside the ED to reduce their ED visits and costly hospital admissions and
institutional care that follows, especially for the increasing numbers of older
adults with HIV.